Menopause may provide migraine relief for many women. Symptoms of migraine decrease in about two-thirds of women who go through menopause naturally, but that number drops to only one-third in women who have surgical or medical menopause (i.e., hysterectomy with ovary removal).

In fact, roughly two-thirds of migraineurs who undergo surgical menopause experience worsening migraine symptoms. This may be due to the sudden drop in estrogen associated with ovary removal.

Hormone replacement therapy (HRT), which is sometimes prescribed to alleviate menopausal symptoms, can be either a blessing or a curse for postmenopausal female migraineurs — studies have found that HRT improves symptoms in 45 percent of women, but worsens symptoms in 46 percent.

In postmenopausal women with a history of migraine who require ERT or HRT, continuous transdermal (i.e., through the skin) treatment that provides a low and steady amount of estrogen to the body is preferred to keep hormone fluctuations to a minimum. This may be in the form of a skin patch or gel.

Large-scale, long-term studies have associated some forms of HRT with an increased risk of cardiovascular disease. The Women's Health Initiative (WHI) studied the effects of HRT use in over 27,000 women and found that estrogen plus progestin hormone replacement therapy increased the risk of heart attack, stroke, blood clots, and certain types of cancer. Estrogen-only HRT increased the risk of stroke and blood clots. While no specific studies have analyzed the use of HRT in women who have migraine with aura, because of the increased stroke risk associated with the latter it may not be the best treatment choice for postmenopausal women with the condition. If you are considering HRT as a migraine treatment, talk to your doctor about the potential risks and benefits in light of your specific health history.

In a very small percentage of women, migraine may appear for the first time following menopause. Because of the rarity of a postmenopausal migraine diagnosis, any new chronic headache that appears after age forty-five, especially one with accompanying visual disturbances or severe debilitating pain, should be evaluated by a health care provider immediately to ensure that the symptoms are not the sign of a developing neurological illness.